Free lateral tarsal artery perforator flap with functioning extensor digitorum brevis muscle for thenar reconstruction: a case report

In this case report, we describe reconstructive surgery in one patient using a free lateral tarsal artery perforator flap with a functioning extensor digitorum brevis muscle. A 47-year-old woman sustained a crush–avulsion injury to her dominant right hand while working in a factory. A large thenar skin and muscle defect (5.5 cm × 4.0 cm) occurred as a consequence of surgical debridement. The skin and muscle defect was repaired using a free lateral tarsal artery perforator flap with a functioning extensor digitorum brevis muscle in a single operation. The donor site defect was repaired using a full-thickness skin graft. The patient recovered without postoperative complications. The patient showed satisfactory functional gain without significant donor site morbidity at the 4-year follow-up visit. Thus, we have demonstrated that a functional reconstruction of a thenar skin defect complicated by muscle loss is possible by transferring a free lateral tarsal artery perforator flap with the underlying extensor digitorum brevis muscle.